Background
Method
Study design and participants
Procedures
Quantitative data
Exposures
Outcomes
Other covariates
Data analysis
Results
Quantitative analysis
Unemployed (n = 3910) | Agriculture related (n = 1937) | Industry related (n = 237) | Business and white collar (n = 3641) | Total (n = 9725) | |
---|---|---|---|---|---|
Maternal age, year (SD) | 28.59 (4.98) | 27.57 (5.51) | 29.58 (4.02) | 30.53 (4.69) | 29.15 (5.11) |
Pre-pregnancy BMI, Kg/m2 (SD) | 22.38 (9.07) | 22.38 (5.13) | 22.91 (4.38) | 22.04 (6.91) | 22.26 (7.37) |
Gestational age, week (SD) | 38.99 (1.43) | 39.15 (1.37) | 38.92 (1.26) | 38.93 (1.45) | 38.99 (1.41) |
Infant birthweight, kg (SD) | 3.42 (0.59) | 3.27 (0.56) | 3.34 (0.50) | 3.42 (0.77) | 3.36 (0.66) |
Infant age, month (SD) | 5.39 (3.44) | 5.65 (3.41) | 5.34 (3.37) | 5.26 (3.42) | 5.38 (3.44) |
Infant sex, n (%) | |||||
Male | 2023 (51.74) | 985 (50.85) | 109 (45.99) | 1808 (49.66) | 4925 (50.64) |
Female | 1887 (48.26) | 952 (49.15) | 128 (54.01) | 1833 (50.34) | 4800 (49.36) |
Parity, n (%) | |||||
Primiparous | 1624 (41.53) | 729 (37.64) | 71 (29.96) | 1991 (54.68) | 4415 (45.40) |
Multiparous | 2286 (58.47) | 1208 (62.36) | 166 (70.04) | 1650 (45.32) | 5310 (54.60) |
Delivery method, n (%) | |||||
Vaginal delivery | 2220 (56.77) | 1263 (65.19) | 92 (38.94) | 1994 (54.76) | 5571 (57.29) |
Cesarean section | 1690 (43.23) | 674 (34.81) | 145 (61.06) | 1647 (45.24) | 4154 (42.71) |
Region, n (%) | |||||
Urban | 2532 (64.76) | 649 (33.51) | 80 (33.76) | 3116 (85.58) | 6377 (65.57) |
Rural | 1378 (35.24) | 1288 (66.49) | 157 (66.24) | 525 (14.42) | 3348 (34.43) |
Maternal education, n (%) | |||||
Primary school and below | 287 (7.34) | 456 (23.54) | 5 (2.11) | 38 (1.04) | 786 (8.08) |
Middle School | 1784 (45.63) | 1261 (65.10) | 122 (51.48) | 386 (10.60) | 3553 (36.53) |
High/Vocational School | 1009 (25.81) | 159 (8.21) | 59 (24.89) | 527 (14.47) | 1754 (18.04) |
College and above | 830 (21.23) | 61 (3.15) | 51 (21.52) | 2690 (73.88) | 3632 (37.35) |
Resident status, n (%) | |||||
Local | 2314 (59.18) | 1574 (81.26) | 175 (73.84) | 2024 (55.59) | 6087 (62.59) |
Migrant | 1596 (40.82) | 363 (18.74) | 62 (26.16) | 1617 (44.41) | 3638 (37.41) |
Employment status, n (%) | |||||
Informal | / | 1916 (98.92) | 176 (74.26) | 1089 (29.91) | 6774 (69.66) |
Formal | / | 21 (1.08) | 61 (25.74) | 2552 (70.09) | 2951 (30.34) |
Had breastfeeding intention, n (%) | |||||
Never/Rarely | 29 (0.74) | 17 (0.88) | 1 (0.42) | 29 (0.80) | 76 (0.78) |
Sometimes/Often | 249 (6.37) | 46 (2.38) | 19 (8.02) | 317 (8.73) | 631 (6.50) |
Always | 3628 (92.88) | 1870 (96.74) | 217 (91.56) | 3286 (90.47) | 9001 (92.72) |
Unemployed | Agriculture related | Industry related | Business and white collar | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % |
n
| % |
n
| % | |
Early initiation | 2672 | 68.34 | 1407 | 72.64 | 156 | 65.82 | 2755 | 75.67 | 6990 | 71.88 |
Current BF | 3371 | 86.21 | 1780 | 91.89 | 216 | 91.14 | 3107 | 85.33 | 8474 | 87.14 |
Ever BF | 3794 | 97.21 | 1894 | 97.88 | 230 | 97.05 | 3566 | 98.16 | 9484 | 97.69 |
Exclusive BF (0–6 months) | 298 | 15.05 | 205 | 22.14 | 15 | 12.00 | 241 | 12.65 | 759 | 15.38 |
Predominant BF (0–6 months) | 634 | 32.02 | 490 | 52.92 | 33 | 26.40 | 404 | 21.21 | 1561 | 31.62 |
Adjusted Odds Ratios (95% Confidence Intervals) | |||||
---|---|---|---|---|---|
Early initiation | Current BF | Ever BF | Exclusive BF (0–6 months) | Predominant BF (0–6 months) | |
Unemployed | 1 | 1 | 1 | 1 | 1 |
Agriculture related | 1.32 (1.15, 1.51) | 1.76 (1.41, 2.20) | 1.69 (1.09, 2.62) | 1.30 (1.04, 1.62) | 1.72 (1.44, 2.05) |
Industry related | 1.00 (0.75, 1.34) | 1.19 (0.73, 1.94) | 0.81 (0.35, 1.87) | 0.77 (0.44, 1.34) | 0.72 (0.47, 1.09) |
Business and white collar | 1.38 (1.23, 1.56) | 0.98 (0.83, 1.15) | 1.64 (1.12, 2.39) | 0.95 (0.78, 1.17) | 0.81 (0.68, 0.95) |
Adjusted Odds Ratios (95% Confidence Intervals) | ||||||
---|---|---|---|---|---|---|
Early initiation | Current BF | Ever BF | Exclusive BF (0–6 months) | Predominant BF (0–6 months) | ||
Local | Formal | 1 | 1 | 1 | 1 | 1 |
Informal | 0.93 (0.62, 1.39) | 0.71 (0.54, 0.94) | 0.87 (0.49, 1.55) | 1.14 (0.78, 1.65) | 1.33 (0.99, 1.78) | |
Migrant | Formal | 1 | 1 | 1 | 1 | 1 |
Informal | 0.59 (0.38, 0.90) | 0.69 (0.51, 0.92) | 0.63 (0.35, 1.14) | 1.29 (0.86, 1.92) | 1.30 (0.94, 1.78) |
Qualitative analysis
Social demographic | Number (total = 84) | Percentage, % |
---|---|---|
Maternal occupations | ||
Unemployed | 36 | 43 |
Agriculture-related | 3 | 4 |
Business & White collar | 45 | 53 |
Maternal education | ||
Primary school | 5 | 6 |
Middle school | 23 | 27 |
High school | 17 | 20 |
College and above | 39 | 47 |
Maternal region | ||
Local | 53 | 64 |
Migrant | 31 | 36 |
Household income | ||
≤ 50,000 yuan | 23 | 27 |
50,000–100,000 yuan | 29 | 35 |
100,000–200,000 yuan | 20 | 24 |
≥ 200,000 yuan | 12 | 14 |
Delivery method | ||
Vaginal delivery | 41 | 49 |
Cesarean section | 43 | 51 |
Infant sex | ||
Female | 41 | 49 |
Male | 43 | 51 |
Theme | Sub-theme | |
---|---|---|
Paid maternity leave | Breastfeeding breaks | |
Employment benefits | + paid maternity leaves for formally employed mothers | + legally required breastfeeding breaks for formally employed mothers |
- no guarantee for paid maternity leaves for informally employed mothers | - difficulty of utilizing breastfeeding breaks for mothers who work far from home | |
- potential financial burden during maternity leave for informally employed mothers | ||
Mother’s commute time | Proximity of family support | |
Commute time | - great distance from home and heavy traffic problems | + proximity and accessibility to family support for some informally self-employed workers |
+ proximity of workplace to home | ||
Space for lactation | Equipment for pumping breastmilk | |
Workplace environment | - lack of lactation rooms | - lack of basic equipment for pumping and storing breastmilk, such as electricity and refrigerator |
+ some public space can be used for breastfeeding and pumping, but privacy and hygiene are not always ensured | ||
Flexibility of work schedule | Stress from work | |
Labor intensity | + flexible work schedule allows some working mothers to breastfeed during the day | - heavy and stressful workload |
- special work requirements that impeded breastfeeding attempts | ||
- special work requirements such as night shift |
Theme 1: Employment benefits
Sub-theme 1: Paid maternity leave
“I have been on maternity leave for six months now, but I would love to be on maternity leave for even longer, so that I can spend more time with the kids. Because I have night shifts from time to time, if I return to work, it means that I have to wean”. (QH10).
“It is so hard for us to continue breastfeeding. .. I am very tired and sleepy at work because I have to get up several times at night to feed her whenever she cries. I still have to get up early every morning to go to work. .. I wish I can have a longer maternity leave. ..” . (2JL19).
“Working at the supermarket was not exactly very convenient. .. I mean, the boss could understand that I need to breastfeed for the first several months after birth, but when it is time to wean you need to wean. It is common for people in this neighborhood to wean when the baby is 1 year old. This was also when I decided to wean. If the situation allows, you can continue breastfeeding. But when the situation does not work and you need to work, you need to wean”. (QH05).
“I knew the boss. He said I could take the break as long as I wished. .. But, uh, considering our future financial needs for the milk powder, and the tuition fees for schools, and so on, I told him I didn’t want go on leave for too long and I was willing to go to back to work soon. ..” . (GD04).
Sub-theme 2: Breastfeeding breaks
“There is one hour in total for breastfeeding breaks, half an hour in the morning and half an hour in the afternoon. .. It is enough for me (to commute back and forth between workplace and home), because my home is very close to where I work. .. I drive home to breastfeed my baby every day because it only takes me two minutes”. (JL08).
“I don’t think of one hour breastfeeding break as particularly useful nowadays for working mothers, but it is better than nothing. I was thinking that the breastfeeding breaks might be more suitable for the past, just like the age of our mothers’ times. Many of them live very close to where they work back then, so they can go home at noon to feed the children and go back to work after feeding. But now, like me, I have to travel for about an hour from work to home, and so I am actually not able to feed my child during that only one-hour break time. .. But my colleagues and I can use that break to pump sometimes”. (BJ01).
Theme 2: Commute time
Sub-theme 1: Mother’s commute time
“Just like a nurse in our department, she is given breastfeeding breaks to pump milk. .. She can also go home to breastfeed the baby because our city is very small. .. It only takes ten to twenty minutes to go back home and so she can come back in one hour. However, Beijing has a different conception of the distance. My brother lives in Beijing and I have been there several times. Life in Beijing is fast-paced and highly stressful. .. There are too many cars and there is always traffic jam. You cannot finish two things in one day”. (JL20).
“There is an hour of breastfeeding break for us, but it is a long commute between home and workplace. Going back and forth, it can add up to three to four hours. Going back at noon means not being able to go back to work for the afternoon. People in the unit would not let me just leave if there is so much work to do. ..” . (SD01).
Sub-theme 2: Proximity of family support
“If the baby was hungry, his grandfather would take him to the breakfast stand so that I could breastfeed him. .. After breastfeeding, his grandfather would take him back home. .. The stand was just across the street. His grandfather could come to help me with the customers so that I could breastfeed the baby”. (GD11).
Theme 3: Workplace environment
Sub-theme 1: Space for Lactation.
“I pump the milk out and my husband drives to my office to pick it up every day. .. I am glad that our city is small so that I can continue breastfeeding. It would be much harder for me if I lived in Beijing”. (2JL19).
“At the beginning, I will pump the breast milk in the morning and in the afternoon. Then I will go home a little bit earlier than usual. My office is not as big as it used to be, but it is relatively private now. It used to be a complete open space. Now we can close the door. We only have four people in our department so I can pump in the office as long as I close the curtain. .. My colleagues and I are quite close, so my male colleagues would leave the room when I pumped. They were very nice”. (JS03).
“It (a well facilitated lactation room) will at least provide me a private space where I can pump without rush. Now I can only pump in the bathroom, which is very dirty. What’s worse is that I have to rush because people are waiting outside. ..” . (BJ02).
“In the supermarket where I worked, it is fine (to breastfeed) if there are just a few customers, but I always do it at home. It was inconvenient there, and it is very dirty. You have to wash your hands every time before breastfeeding, but you can hardly find a proper place to wash your hands there. .. There is only a small area separated from the outside by a curtain, where there is a bed for my boss and his families to take a break. .. I could use that space, I occasionally do. .. However, I seldom do that. I always breastfeed at home”. (QH05–1).
Sub-theme 2: Equipment for pumping breastmilk
“Without a refrigerator, the storage and preservation of breast milk is also a big problem. Even if you have ice packs, the ice packs can easily melt. Breast milk must be kept at a low temperature”. (JS04–1).
“You have to go to the bathroom to pump, where there usually are no power outlets to charge the electric breast pump. Suction is thus less effective. It is easy to pump at home, but it is hard to pump it out in such settings. .. It is very stuffy in the bathroom. .. In addition, that place gets me uncomfortable. .. makes me feel bad. ..” . (JS04–2).
Theme 4: Labor intensity
Sub-theme 1: Flexibility of work schedule
“It takes me about five minutes to go to the socks factory by bus. .. My job is very flexible. The length of the leave is casual. You can ask for the leave as long as you want. .. I have been on leave for 15 months after I was pregnant. .. I knew the boss. Anyway, I can have a break at noon after I resume work. After feeding in the morning, I come back to feed at noon”. (JL07–1).
“It didn’t make much of a difference because I worked on the farm while the baby was asleep. It hardly delays the baby’s feeding. .. Baby is breastfed mainly. If I am too busy and away, my family will feed him formula milk and other supplementary food. .. We always put the baby at the first place. ..” . (GZ08).
“Our colleagues all reported that the milk was less after work, because the frequency of breastfeeding practices decreased. .. I started to add complementary food before I resumed work. .. so the baby would not feel unaccustomed or hungry when I am not around. ..” . (JN07).
Sub-theme 2: Stress from work
“The production of breastmilk decreased as I started to work because there was much work waiting for me to finish. When I returned to work (from maternity leave), I worked overtime almost every day for about a month. Though I can get off work at 5:30pm, I usually had to stay for another one or two hours because there were a lot of work for me to finish. No one could help me. .. There were about six months’ work waiting for you. Your colleagues cannot replace you because the materials we make are very complicated. .. you can only finish it on your own”. (GD01).
“I could have over 100 days of paid maternity leave plus the university’s summer vacation. However, you know about working in a university. .. people started calling me one month after giving birth. .. was on and off. .. There was never a single minute that I am only carrying the responsibility of being a mother. No, there was not … balancing work, family and other stuff is difficult for a breastfeeding mom”. (JS06).
“My breastmilk was always enough (for my baby). However, my job is very tiring and lots of stuff in our company are continuously coming out. I think it (the stress) had some influences on production of breastmilk so the volume of my breast milk gradually decreased. .. After resuming work, I always try to satisfy his needs and accompany him. .. I still breastfeed him, but I have to add some milk powder for him now”. (JS06–1).
“The inconvenience at workplace was one of the reasons. I worked at the first floor of the hall so I had to help people with lots of questions even though I had my own office room. It would be very inconvenient for me to suspend work from time to time and go inside to breastfeed him. I think it would be better for me to only breastfeed him at home”. (QH10).